Sociodemographic and clinical factors, visit expectations and driving factors for emergency department attendance for uncomplicated upper respiratory tract infection

Abstract

BackgroundUpper respiratory tract infections (URTIs) account for substantial non-urgent ED attendances. Hence, we explored the reasons for such attendances using a mixed-methods approach.MethodsWe interviewed adult patients with URTI who visited the second busiest adult ED in Singapore from June 2016 to November 2018 on their expectations and reasons for attendance. A structured questionnaire, with one open-ended question was used. Using the Andersen’s Behavioural Model for Healthcare Utilisation, the topmost reasons for ED attendances were categorised into (1) contextual predisposing factors (referral by primary care physician, family, friends or coworkers), (2) contextual enabling factors (convenience, accessibility, employment requirements), (3) individual enablers (personal preference and trust in hospital-perceived care quality and efficiency) and (4) individual needs (perceived illness severity and non-improvement). Multivariable multinomial logistic regression was used to assess associations between sociodemographic and clinical factors, patient expectations for ED visits and the drivers for ED attendance.ResultsThere were 717 patients in the cohort. The mean age of participants was 40.5 (SD 14.7) years, 61.2% were males, 66.5% without comorbidities and 40.7% were tertiary educated. Half had sought prior medical consultation (52.4%) and expected laboratory tests (55.7%) and radiological investigations (46.9%). Individual needs (32.8%) and enablers (25.1%) were the main drivers for ED attendance. Compared with ED attendances due to contextual enabling factors, attendances due to other drivers were more likely to be aged ≥45 years, had prior medical consultation and expected radiological investigations. Having a pre-existing medical condition (adjusted OR (aOR) 1.78, 95% CI 1.05 to 3.04) and an expectation for laboratory tests (aOR 1.64, 95% CI 1.01 to 2.64) were associated with individual needs while being non-tertiary educated (aOR 2.04, 95% CI 1.22 to 3.45) and having pre-existing comorbidities (aOR 1.79, 95% CI 1.04 to 3.10) were associated with individual enablers.ConclusionsMeeting individual needs of perceived illness severity or non-improvement was the topmost driver of ED visits for URTI, while contextual enabling factors such as convenience was the lowest. Patients’ sociodemographic and clinical factors and visit expectations influence their motivations for ED attendances. Addressing these factors and expectations can alleviate the overutilisation of ED services.

Registered incidence of acute upper respiratory tract infections diagnosed by primary care physicians in Poland – 5-year retrospective analysis of the national health insurance database

“…Also, in the Dutch research, the most common reason for patients with acute URTIs to visit a PHC physician was a common cold, which is consistent with our results [13]. A study by Chow et al and colleagues showed that in Singapore, as in Poland, otitis media is the most common cause of referrals to specialist care [15].…”

“…Overall, about 15% of all consultations in Dutch general practice were related to respiratory tract infection illness [13]. URTIs are usually managed by PHC physicians, but other levels of care might also be involved, with accute URTIs accounting for up to 20% -25% of emergency department (ED) visits [14,15].…”

Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic

“…Patients seek non-urgent care in the ED for a myriad of reasons. These reasons include lack of access to primary healthcare facilities, lack of diagnostic services in primary care, referrals from primary care facilities, easy access to EDs, patient perceptions regarding the severity of their condition, and perceptions of better care in EDs (2,3,5,9,10). Efforts to mitigate ED overcrowding, such as teleconsultation, education on appropriate usage of ED services, and improving primary care access, have shown mixed results (11)(12)(13).…”